A NEW METAL STENT WITH CONTROLLED RELEASE SYSTEM (EVOLUTION) FOR THE PALLIATION OF MALIGNANT DYSPHAGIA: A PROSPECTIVE FOLLOW-UP STUDY

Abstracts / Digestive and Liver Disease 41S (2009), S1–S167 endoscopic landmarks were more frequently identified/reported and an increasing number of biopsy samples per patient was also obtained (Table 2). Conclusions: EBRA-Registry activity resulted into a significant improvement of diagnostic accuracy in BE assessment. # A. Oesophagus 4. Barrett

P.14 USEFULNESS OF NARROW BAND IMAGING (NBI) FOR DETECTION AND SURVEILLANCE OF BARRETT’S ESOPHAGUS (BE) O. Labianca ∗ , L. Gargiulo, G. Napoli, G. Quagliariello, G. Sabarese, A. Maurano Gaetano Fucito Hospital, Mercato San Severino, Salerno Background and aim: Sometimes, the identification of Barrett’s Esophagus (BE) may be not so easy, with difficulties to perform targeted biopsies to detect histo-pathological abnormality. Therefore, many endoscopic techniques have been used in order to better identify BE. We studied the usefulness and accuracy of Narrow Band Imaging (NBI), an optical high-resolution imaging technique that enhances the minute morphological details of the mucosal surface, for the diagnosis and surveillance of BE. Material and methods: From June 2007 to October 2008, we observed nine patients (7 males, 2 females; range age 35-74 years; mean age 56.2 years) with suspected BE (3) and with BE under surveillance (6) underwent upper GI endoscopy with an HDTV/NBI System Olympus Exera II (Videogastroscope GIF-H180) by an experienced endoscopist. NBI directing biopsies were taken on selected abnormal appearing mucosa, across and 1 cm. above Z-line, every 2 cm. on four quadrants of suspected BE, and the relationship between HDTV/NBI endoscopic findings in the distal esophagus and histopathological diagnoses was examined. This endoscope lighting system, based on a special set of optical filters that sharpen contrast, described as “electronic chromoendoscopy”, emphasizes certain histological features in BE such as specific microvascular and pit pattern, improving the visualization of the esophagogastric junction and sub-epithelial palisade capillaries. Results: In one patient, NBI endoscopy evidenced a regular mucosal surface and a normal small vessel pattern with the absence of BE columnar epithelium confirmed at the histology. In six patients, NBI showed a mild irregular mucosal pit pattern with slightly dilated and tortuous longitudinal small vessels; in these cases histology showed low grade dysplasia in 2 and BE non-dysplastic specialized intestinal metaplasia in 4. In the remaining two patients, NBI evidenced an irregular distorted villous/gyro-forming mucosal pattern, with abnormal severe dilated and tortuous longitudinal small vessels; in these cases target biopsies and histology confirmed a more advanced pathological abnormality, showing mild grade dysplasia in 1 and high grade dysplasia in 1. Conclusions: NBI with magnification is absolutely useful to distinguish mucosal morphologic characteristics of BE, for detection of dysplasia, allowing a significantly high accuracy to direct selective biopsies without chromoendoscopy, improving the effectiveness and efficiency of endoscopy. # A. Oesophagus 4. Barrett

P.15 OESOPHAGEAL AND GASTRIC 24 HOURS pH PROFILES IN PATIENTS WITH BARRETT’S OESOPHAGUS TREATED WITH PROTON PUMP INHIBITORS G. Cataudella ∗ , L. Cuoco, D. Bernardini, M. Salvagnini S. Bortolo Hospital, Vicenza Background and aim: It is assumed that acid suppression with proton

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pump inhibitors (PPIs) improves or eliminates symptoms reflux-related by normalizing intra-oesophageal pH. However, the degree of acid suppression induced by PPIs in patients (pts) with Barrett’s oesophagus (BE) has not been extensively studied. Aim: To assess the efficacy of PPIs in normalizing intraesophageal pH and suppressing acid gastric secretion in pts with BE who achieved asymptomatic status. Material and methods: 17 pts (13 M; 4 F; mean age 60,5 yrs; range 37-78 yrs), with acid reflux-related symptoms and endoscopic and histologic diagnosis of BE, were consecutively studied by oesophagealgastric 24-h pH monitoring prior to therapy and at least after 1 month while receving PPI therapy with complete control of reflux symptoms. The PPI use for number of pts-mean dose mg-(range) was respectively: Esomeprazole 7- 40- (40); Pantoprazole 3-53-(40-80); Rabeprazole 425-(20-40); Lansoprazole 2- 45-(20-40); Omeprazole 1-20- (20). Data were analyzed with student’s t test. Results: 9/17 (53%), 4/17 (24%) and 13/17 (76%) pts were classified endoscopically as having hiatal hernia, long segment BE and shortsegment BE respectively. All the pts tolerated PPIs therapy well and were still symptom-free at the time of repeating dual channel 24-h ambulatory pH monitoring. In the total group of pts the intraesophageal mean percentage of total time with pH <4 significantly decreased (mean ± S.D.: 18,6±8,8 pre-PPI vs 7,0±6,2 on-PPI; p<0.001) but not normalised to normal value (i.e. 4,2% of total time with pH< 4 in the distal oesophagus according to DeMeester system) on-PPI therapy. An abnormal oesophageal acid exposure continued in 53% (9/17) of pts despite PPI. Only 8 pts normalized their intraesophageal pH profiles on-PPIs. In the total group of pts on-PPI therapy the intragastric mean percentage of total time with pH < 4.0 significantly decreased (mean ± S.D.: 91,6±5,9 vs 41,5±17,5; p< 0,001) but remained low for approximately 42% of total time. Conclusions: A significant percentage of pts with BE mantain pathologic gastro-oesophageal reflux and low intragastric pH despite PPIs that has eliminated their reflux related symptoms. These findings may have significant therapeutic implications concerning the impact of medical therapy on intestinal metaplasia extension and displastic progression in BE pts. # A. Oesophagus 4. Barrett

P.16 A NEW METAL STENT WITH CONTROLLED RELEASE SYSTEM (EVOLUTION) FOR THE PALLIATION OF MALIGNANT DYSPHAGIA: A PROSPECTIVE FOLLOW-UP STUDY A. Repici ∗ ,1 , P. Siersema 2 , G. Rando 1 , N. Pagano 1 , A. Carlino 1 , F. Vleggaar 2 , B. Solito 3 , G. Strangio 1 , F. Romeo 1 , C. Cortelezzi 4 , P. Omodei 1 , A. Malesci 1 1 Dept. of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milano; 2 Dept. of Gastroenterology, UMC, Utrecht, Netherlands; 3 Surgical Unit, Ospedale di Pisa, Pisa; 4 Dept. of Gastroenterology, Varese

Background and aim: Self expanding metal stents are frequently used for the palliation of malignant dysphagia. Recently, a new stent design, the Evolution stent (Cook Medical, Limerick, Ireland), was developed. The stent has an internal and external silicone coating to resist tumor ingrowth and uncoated dual flanges on both ends to anchor the stent in the esophageal wall. Its controlled release system allows full control and enables precise positioning of the stent. In the present study, we determined safety and clinical effectiveness of the Evolution stent for the palliation of dysphagia in patients with esophageal (n=33 [77%]) or gastric cardia cancer (n=10 [23%]). Material and methods: All patients who underwent placement of an esophageal Evolution stent from February - November 2008 were

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Abstracts / Digestive and Liver Disease 41S (2009), S1–S167

followed up by telephone calls at 14 days after treatment and then monthly until 6 months or until death. Data was collected with respect to technical and clinical outcome, recurrent dysphagia, complications. Results: A total of 44 patients (31 (70%) males, median age 73 (48-91) years) were treated with an Evolution stent. Reasons for being inoperable included metastases (n=25 [57%]), local irresectability (n=10 [23%]) or a poor medical condition (9 [20%]). Median tumor length was 6 cm (1-11). Eleven (25%) patients underwent previous radiation and/or chemotherapy. Stent placement was successful in all patients. Dysphagia improved from a median of 3 (ability to swallow liquids only) to 1 (ability to eat some solid foods) 4 weeks after stent placement. Major complications (pneumonia [n=3] and perforation [n=1]) occurred in 4 (9%) patients. There was no stent-related mortality. Minor complications included regurgitation and mild retrosternal pain in 11 (25%) and 9 (20%) patients, respectively. Five (11%) patients developed recurrent dysphagia due to tissue overgrowth (n=2 [4.5%]), stent migration (n=2 [4.5%]), or inadequate stent expansion (n=1 [2%]). Conclusions: The Evolution stent is safe and effective for the palliation of dysphagia from esophageal and gastric cardia cancer. The controlled release system enables precise positioning of the stent in the esophagus. # A. Oesophagus 7. Endoscopic therapies

P.17 LONG-TERM FOLLOW-UP OF CHILDREN WITH BLEEDING ESOPHAGEAL VARICES TREATED BY ENDOSCOPIC BAND LIGATION D. Reggio 2 , C. Giordanino 3 , C. Barletti 3 , M. Baronio 3 , A. Repici 2 , P. Calvo 5 , M. Baldi 5 , R. Romagnoli 2 , C. Sanna 3 , M. Salizzoni 2 , M. Rizzetto 3 , G. Saracco ∗ ,3 1 Dipartimento

di Gastroepatologia - Ospedale San Giovanni Battista Molinette di Torino, Torino; 2 Unità di Gastroenterologia ed Endoscopia - IRCCS Istituto Clinico Humanitas, Milano; 3 Dipartimento di Gastroenterologia Pediatrica - Università di Torino, Torino

Background and aim: Although there are some reports concernine long-term follow-up of endoscopic variceal ligation (EVL) in adults, very few studies have been done in children. Aim of this study was to assess the long-term safety and efficacy of EVL in children with bleeding esophageal varices. Material and methods: From January 2001 to December 2007, 14 consecutively collected children with bleeding esophageal varices were mechanically ligated using an elastic band ligature device attached to a flexible - endoscope. Each of them (except one lost to follow-up) was followed-up up to now (mean follow-up: 3.4 yrs ± SD 2.8). Outcome was assessed with respect to survival, rebleeding and complications. Results: The cause of portal hypertension were neonatal onphalitis (5, 38.4%), biliary atresia (4, 30%), idiopathic portal hypertension (3, 23%), primary liver fibrosis (1, 8.6%). Of 13 children (mean age 9.2 yrs ± SD 5.3, M= 9, F= 4), 4 (30%) subsequently underwent liver transplantation, 3 (23%) were surgically treated by porto-systemic shunts, 1 (1.8%) died for variceal rebleeding after the first session of EVL, the remaining 5 (38.4%) had their varices eradicated; the 7 surgically treated children and the 5 endoscopically treated children are all alive: in particular, no complications related to the endoscopic procedure was reported. Conclusions: EVL is effective in controlling variceal hemorrhage in children with portal hypertension, regardless of etiology; its efficacy is maintained over the long-term. The complications rate is very low even though risk of life threatening rebleeding is present. # A. Oesophagus 7. Endoscopic therapies

P.18 CLINICAL VARIATION IN ITALIAN PATIENTS WITH NONVARICEAL UPPER GASTROINTESTINAL HEMORRHAGE: DATA FROM 2003-2007 M. Soncini ∗ ,1 , O. Triossi 2 , P. Leo 3 , G. Magni 4 1

A.O. San Carlo Borromeo, Milano; 2 Ospedale S. Maria Delle Croci, Ravenna; 3 Ospedale Annunziata, Cosenza; 4 Qbgroup, Padova Background and aim: Nonvariceal Upper Gastrointestinal Hemorrhage (NVUGH) is a frequent cause of ordinary hospital admission in Gastroenterology Units, as observed in previous studies. In the last years, despite advances in clinical and endoscopic tecniques, we have not observed changes in outcomes like mortality or days of hospital stay. Aim of the present study is to find any changes in the patients characteristics, in the Italian units of Gastroenterology participating to the RING study group, during the last 4 years. Material and methods: We analyzed the hospital discharge files collected between June 2003 and June 2007 from 12 Gastroenterology Units, which issued 2038 hospital discharge files of ordinary hospital admission using the Rockall score for defining NVUGH. Results: A total of 2038 patients (males 64.7%) with a main diagnosis of NVUGH were identified. The mean age was 67.8±16.4 years, increasing in the observation years from 66.0±16.7 to 68.8±16.1 years. Patients presented a mean comorbity of 2.3±1.3. Length of stay (6.8±4.2 days), mortality (2.1%) and rebleeding (6.1%) of patients with NVUGH did not differ in the same period of observation. In this time the patients with Rockall score elevated, (six or more) increased from 31.5% to 35%; while those with low risk (0-2) remained stable (17,4%). The distribution of the main diagnosis was: duodenal ulcer 44.5%, followed by gastric ulcer 31.5%, haemorrhagic gastroduodenitis 6.5%; undefined causes 5.7%, Mallory-Weiss tear 4.8%, gastroduodenal angiodysplasia 2.0%. 57% of the patients required at least one blood trasfusion with an increase in the years, from 53.7% to 61.5%. Conclusions: Our study, on a considerable number of patients and for a long period of observation, demonstrates that subjects with NVUGH are becoming older and have many comorbities. This is documented also by the increase in the time of the subjects with high Rockall score, who represent more than 1/3 of the observed population. As consequence there is a high request for blood transfusions, which requires a strait monitoring, as for the medical and endoscopic therapy. # B. Gastric diseases 1. Peptic ulcer

P.19 IRON-INDUCED MUCOSAL INJURY TO THE STOMACH G. Spinzi ∗ , M. Feltri, L. Ambrosiani, E. Ceretti Ospedale Valduce, Como Background and aim: Mucosal injury to the upper gastrointestinal (GI) tract following iron overdose is well recognized, particularly in children. Gastric injury from standard therapeutic oral iron is a less well-known condition, despite its characteristic histological pattern and the prevalence of oral iron therapy. The aim of this study was to describe the clinical and histopathological features of gastric injury related to oral iron in a series of 3 patients. Material and methods: Over a period of 3 years, 3 female patients (average age 58.7 years, range 39-86) were evaluated in an open access Endoscopy Unit. All 3 patients were taking oral therapeutic iron (ferrous sulphate) and had been investigated for iron-deficiency anaemia for which no definitive cause had been previously identified. In two cases the endoscopist described gastric erosions. Another patient presented with an eritematous area with a dark mucosal plaque. Multiple biopsies were obtained from any patient. On hematoxylin and eosin staining, there was brown-black hemosiderin deposition on the epithelial surface,